Financial hardship from medical bills and depression among adults with diabetes in the United States

Objectives To examine the association between financial hardship from medical bills (FHMB) and depression among adults aged 18-64 years with diabetes. Furthermore, to examine the association of FHMB and cost-related barriers to mental healthcare utilization and antidepressant adherence. Methods Descriptive and multivariate logistic regression analyses were conducted using a nationally representative sample of adults with diabetes aged 18-64 from the 2019-2021 National Health Interview Survey data. The study sample was divided into three mutually exclusive categories: (i) no FHMB, (ii) FHMB but currently able to pay, and (iii) FHMB and currently unable to pay bills. Key findings Representing a national estimate of 12 757 425 individuals in the US population, the prevalence of FHMB among adults with diabetes was as follows: 75.66% (95% CI: 74.07, 77.18) reported no FHMB, 8.19% (95% CI: 7.25, 9.23) experienced FHMB but were able to pay, and 16.13% (95% CI: 14.84, 17.51) were unable to pay (P <. 001). Compared to those who reported no FHMB, individuals with FHMB but were able to pay had 44% higher odds of depression, while those unable to pay had even higher odds. FHMB also increased the odds of facing cost-related barriers to mental healthcare utilization and medication adherence. Conclusions Individuals experiencing FHMB have higher odds of experiencing depression, with the odds escalating for those unable to pay their bills. Policy interventions to alleviate healthcare financial burdens and improve access to affordable healthcare services among individuals with diabetes are warranted.